Medical Claims Adjuster

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DA Deborah Araiza

Riverside, CA 92517 909-***-**** ad7mz5@r.postjobfree.com PROFESSIONAL

SUMMARY

Detailed Claims Adjuster with 36 years of experience in Medical insurance claims. Dedicated Medical Claims professional with history of meeting company goals utilizing consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand. Hardworking and passionate job seeker with strong organizational skills eager to secure entry-level position. Ready to help team achieve company goals.

SKILLS Health Insurance Industry

Knowledge

Claim Form Analysis

Healthcare Terminology

HIPAA Regulations

Medical Billing and Coding

Billing Procedures

ICD-9-CM Coding

Data Entry Accuracy

Benefits Verifications

WORK HISTORY CLAIMS ADJUSTER 12/2013 to CURRENT

County Of Riverside Riverside, CA

Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations. Managed large volume of medical claims on daily basis. Paid or denied medical claims based upon established claims processing criteria.

Responded to correspondence from insurance companies. Used administrative guidelines as resource or to answer questions when processing medical claims.

Reviewed provider coding information to report services and verify correctness.

Evaluated accuracy and quality of data entered into agency management system.

Reported policy changes and company conditions affecting customer satisfaction.

Conducted day-to-day administrative tasks to maintain information files and process paperwork.

Examined claims forms and other records to determine insurance

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Examined claims forms and other records to determine insurance coverage.

Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials. Processed EDI claims.

Processed Multi-Plan claims

Coordinated Benefits with other Medical Plans.

Reviewed insurance claims and member eligibility to determine overpayment trends and noncompliance issues.

Prioritized daily tasks to satisfy workload demands and department's turnaround goals.

Researched issues related to claims processing to identify origins and implement corrective solutions.

COLLECTOR 12/2008 to 12/2013

Loma Linda University Health Care Loma Linda, CA Delivered exceptional customer service on collection calls and maintained calm and professional demeanor.

Persistently reached out to customers with extremely past due accounts to recover lost revenue.

Contacted customers to discuss payment schedules and set up or immediately process payments.

Negotiated with account holders to devise repayment plans and minimize collections receivables.

Evaluated, researched and resolved discrepancies.

Achieved performance goals on consistent basis.

Used scripted conversation prompts to convey current account information and obtain payments.

Used skip tracing and other techniques to locate debtors. Monitored accounts for compliance with established payment plans and flagged non-compliances.

Maintained high volume of calls and met demands of busy and productive group.

Managed past due collection calls, skip tracing, outside collections agency coordination and litigation activities.

Trained new collections representatives on collections processes and incentivized team members to achieve production goals. EDUCATION RN Pre-Requisites

San Bernardino Valley College, San Bernardino, CA

RN Pre-Requisites

Riverside City College, Riverside, CA

Medical Claims Examination

United Healthcare Careers College, San Bernardino, CA Update Content

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